In serving in a stressful and traumatic environment, combat veterans often come back with a variety of complicated physical and mental problems.

B. Christopher Frueh, clinical psychologist and professor of psychology at the University of Hawai‘i at Hilo, is researching ways to provide better care and methods of mental health treatment for combat veterans.

Currently, his focus is in treating veterans through a more thorough approach, based in different aspects of the struggles they may face.

A more thorough approach

Instead of addressing a single factor of their physical or emotional health, Frueh says it is more effective to address all of the factors simultaneously for a more cohesive treatment for veterans who experience a variety of medical and psychiatric disorders.

For example, combat veterans often suffer from posttraumatic stress disorder (PTSD) or brain injury as a result of being exposed to dangerous and high-stress environments, which in turn affects a lot of other aspects of their health.

“Many of them have PTSD or depression or anger problems, a lot of them have alcohol or drug abuse problems—these things all connect together,” Frueh explains. “If you have brain injury, you’re going to have sleep dysfunction—if you have sleep dysfunction you’re more likely to drink alcohol and have emotional problems.”

The connection between physical, mental, and emotional health problems gives all the more reason to treat veterans through a holistic approach, which is why Frueh is working on a multicomponent treatment for combat PTSD.

“We’re trying to look at their endocrine functioning, sleep functioning, spirituality, their self-perception, relationships, exercise, physical health, their family lives,” he says.

The treatment is meant to address the behaviors, thoughts, feelings, and bodies of veterans through methods such as exposure therapy and social skills training.

Exposure therapy

Through exposure therapy, the goal is to habituate the experience of being exposed to their feelings of fear and eventually overcome it.

“[Exposure therapy] is a common treatment for PTSD and also for most other anxiety disorders,” explains Frueh. “It involves carefully exposing the patient to what they fear so that they can overcome the fear. In combat PTSD we have patients relive their combat traumas in as much intense detail as possible, usually through their imagination or having them write in a journal.”

Virtual reality (VR)-assisted exposure therapy also has been used to help veterans cope with their PTSD.

“There are VR programs that mimic Iraq and Afghanistan combat, [not only with] with visuals and sounds, but also scents and physical vibrations,” says Frueh. “For example, they sit on a platform that vibrates when there is an explosion, and we cue the unpleasant odors of war.”

Social skills training, such as anger management and behavioral activation has also helped veterans in transitioning to civilian life. Behavioral activation helps veterans who may be struggling with socializing or accomplishing day-to-day activities due to PTSD or depression.

“Behavioral activation is actually a treatment for depression, it’s a behavior treatment that focuses on getting someone who is depressed and spending a lot of time socially isolated to get a schedule that gets them out of the house, gets them accomplishing something with a mission or purpose, gets them socializing,” Frueh says.

Intensive Outpatient Program

Frueh also has been working on an Intensive Outpatient Program (IOP). The program is a variation of a multicomponent treatment that is usually administered over the course of three months, instead delivering it in three weeks.

The IOP works to provide therapy sessions to veterans two times a day, five days a week over a period of a three weeks, providing them with a more condensed and focused treatment experience.

“At our program in Orlando, we administer 28 sessions over the course of three weeks, instead of the usual three months,” says Frueh. “Patients live at an extended stay hotel and come to the clinic for sessions in the morning and again in the afternoon five days a week for three weeks. Essentially, we give them the same dose of therapy, but packing the sessions together instead of spacing them out. It works better.”

According to data collected from the IOP, the program has been found to reduce drop out, enhance clinical outcomes, and is highly accepted by patients, especially active duty personnel.

“Patients have taken off from work, school, family to dedicate to their treatment,” explains Frueh. “By using an intensive outpatient program approach, we treat patients faster. We have found that the percentage of patients who complete treatment is then much higher, for example 95 percent versus 55 percent.”

Through treating veterans with holistic approaches that take into account different factors of their health, hopefully there will be a better understanding of what measures can be taken to give them the proper care they need.

“I would like to see radical transformation of how we treat veterans and how we take care of them,” says Frueh.

Alyssa Mathews is a freshman at the University of Hawai‘i at Hilo planning to major in business with a marketing concentration. She graduated from Waiakea High School and is a UH Hilo Chancellor’s Scholar.